A comparison of the subjective oral health status of older adults from deprived and affluent communities

Does different wording of a global oral health question provide different results?

OBJECTIVE

Focusing on 70-year-old adults in Sweden and guided by the conceptual framework of International Classification of Impairments, Disabilities and Handicaps (ICIDH), the purpose of this study was to examine the extent to which socio-demographic characteristics, self-reported oral disease and social/psychological/physical oral health outcome variables are associated with two global measures of self-assessed satisfaction with oral health in Swedish 70-year-olds and if there is a degree of discordance between these global questions.

BACKGROUND

It has become an important task to create a simple way to measure self-perceived oral health. In these attempts to find practical ways to measure health, the 'global oral health question' is a possible tool to measure self-rated oral health, but there is limited knowledge about how important the wording of this question is.

MATERIALS AND METHODS

In 2012, a questionnaire was mailed to all persons born in 1942 in two Swedish counties, Örebro (T) and Östergötland (E). The total population of 70-year-olds amounted to 7889. Bivariate analyses were conducted by cross-tabulation and Chi-square statistics. Multivariate analyses were conducted using binary multiple logistic regression.

RESULTS

The two global oral health question of 70-year-olds in Sweden was mainly explained by the number of teeth (OR=5.6 and 5.2), chewing capacity (OR=6.9 and 4.2), satisfaction with dental appearance (OR=19.8 and 17.3) and Oral Impact on Daily Performance (OIDP) (OR=3.5 and 3.9).

CONCLUSION

Regardless of the wording, it seems that the concept of a global oral health question has the same main determinants.

A Korean version of the Oral Impacts on Daily Performances (OIDP) scale in elderly populations: validity, reliability and prevalence

BACKGROUND

This study aimed to develop a Korean version of the OIDP index for elderly people and to assess the levels of sociodental impacts in an older Korean population.

METHODS

The OIDP index for elderly people was cross-culturally adapted from English into Korean and then the derived instrument was tested for reliability and validity. The study population was elderly (65+ year-old) residents of Gangneung City, South Korea. Twenty two of the 222 senior day centres were randomly selected.

RESULTS

687 people were invited and 668 participated in the study (response rate: 97.2%). The standardized Cronbach's alpha coefficient was 0.85. The OIDP related significantly with different subjective measures of oral and general health (p < 0.001). 62.9% of the people had oral impacts relating to one or more performances, with eating food being the most frequently affected performance (47.6%). More than 70% of people with oral impacts had up to 3 performances affected by oral health conditions.

CONCLUSION

The Korean OIDP index showed satisfactory validity and internal consistency reliability, confirming its appropriateness for use among older Korean people. The prevalence of oral health related impacts was high. Future studies should focus on the test-retest reliability and the sensitivity to change of the Korean OIDP.

Oral health-related quality of life: a critical appraisalof assessment tools used in elderly people

OBJECTIVE

The purpose of this study was to undertake a critical appraisal of oral health-related quality of life (OHRQoL) measurements used for research in the elderly.

BACKGROUND

A variety of OHRQoL measurements have been developed in the past 20 years as a result of increased concern about the impact of oral conditions on a person's quality of life. There is need for an assessment aimed at prioritising the recommended measurements to be used for different purposes in the elderly.

MATERIALS AND METHODS

Original English language papers using measurements to assess OHRQoL in the elderly were identified from Web of Science, EMBASE, PubMed, Medline and Lilacs databases. The search included all papers published from 1985 to February 2007. The criteria of assessment were: (i) measurement criteria (number of items and domains, and classification of the results found for each measurement); (ii) quantitative-qualitative criteria (frequency, acceptability, reproducibility, reliability, sensitivity and capability of being reproduced in other language versions).

RESULTS

In a total of 152 papers selected, 20 measurements were identified. However, only seven fulfilled all the measurement and quantitative-qualitative criteria.

CONCLUSION

Geriatric Oral Health Assessment Index, Subjective Oral Health Status Indicators, Oral Health Impact Profile-49, Dental Impact on Daily Living, Oral Health Impact Profile-14, Oral Impact on Daily Performances and German Version of the Oral Heath Impact Profile were considered as instruments of choice to assess OHRQoL in the elderly. The other 13 instruments identified require further research aimed at a validation process and the use of a language other than English.

Self-perceived oral health status and influencing factors of the elderly residents of a peri-urban area of La Paz, Bolivia

AIM

To assess the self-perceived oral health status of the elderly in Bolivia and explore the relationship between the socio-demographic and subjective factors that influence such perception.

DESIGN

A cross sectional study.

SETTING

Pampahasi, peri-urban area of La Paz, Bolivia.

PARTICIPANTS

A 22.5% (300) sample was selected randomly from the total population (1,336) of 60 years and above. Of the participants, 293 agreed to participate in the survey.

METHODS

Information was collected by interviews at home.

RESULTS

The mean age was 70 years (SD = 7.7), with more females (57%) than males. Sixty per cent of subjects categorised their oral health as poor. Logistic regression analysis showed that poor self-perceived oral health was associated significantly with not going to school, no/ fair satisfaction with economic status, poor chewing ability, perception of need for dental treatment, and poor self-perceived general health status.

CONCLUSIONS

Socio-economic factors seem to contribute to poor oral health among the elderly in Bolivia. Considering that these factors are associated with bad oral health behaviour and few visits to dental clinics, there is a need to design dental education programmes and enhance accessibility to dental clinics for elderly people living in the peri-urban areas of La Paz, Bolivia.

Self-rated oral health as an independent predictor of self-rated general health, self-esteem and life satisfaction

Self-rated health (SRH) is a useful summary measure of people's general health and was found to predict future health outcomes. Self-rated oral health (SROH) is a similarly useful summary measure of people's oral health. Both are related to quality of life, especially at old age. The objectives of the study were: (1) to assess the independent contribution of SROH to concurrent and future SRH of elderly people, controlling for sociodemographics and health measures, and, (2) to assess whether SROH adds unique information not captured by SRH by testing their independent associations with self-esteem and life satisfaction. Participants were 850 residents of a retirement community (mean age 73) interviewed in their homes at baseline and 5 years later. The interview included single-item self-ratings of general and oral health, self-reports of medical history, recent chronic diseases, medication usage, functional disability, self-esteem and life satisfaction. Multiple regression analyses showed that SROH had an independent effect on concurrent and future SRH, controlling for age and other measures of health status. Both SRH and SROH independently explained a significant amount of variance in concurrent ratings of self-esteem and life satisfaction. SROH has a unique role in people's perceptions of their overall health yet is not fully captured by SRH. Therefore, it should be considered by general health care providers in their assessments of the health status of older adults.

Dental status and oral health quality of life in economically disadvantaged French adults

Expansion of French health insurance coverage has increased funding for dental care for economically disadvantaged adults. This study aimed to measure clinical and self-perceived oral health, behaviors, and use of dental services by adults who were eligible for such coverage. The regional agency that gives administrative services for the health insurance funds provided a sample of 900 adults aged 35-44 years, insured through this program. We reached 805 of these adults by mail; of these 18% were surveyed and clinically examined. Self-perceived oral health was measured by the Global Oral Health Assessment Index (GOHAI) and participants' attitudes to dental health, by questionnaire. Decayed and Missing teeth constituted 40% of the DMFT. Participants reported poor oral health (63%), and 79% perceived a need for care, although they used dental services infrequently and had poor knowledge of available services. Cost of care and number of carious teeth were important predictors of the GOHAI.

Oral health: perceptions of need in a rural Iowa county

Several studies have shown that oral health problems impact the quality of life of older adults. However, few data are available to describe the oral health status, barriers to care, and patterns of care for adults and older populations living in rural areas. The purpose of this study was to evaluate the perceived need for treatment of oral health problems by adult residents in a rural county in Iowa. The oral health component was part of a larger longitudinal health study of the residents. The sample was stratified into three groups by residence, that is, farm households, rural non-farm households and town households. The sample was subsequently post-stratified by gender and age group into young elderly, 65-74 years old, and old elderly, 75 years and older. Dentition status varied according to age and was related to the perception of treatment needs. Edentulous persons had fewer perceived treatment needs and utilized a dentist less frequently. Place of residence, education, and marital status were not associated with the subjects' perceived problems with eating and chewing. However, persons with difficulty chewing were more likely to have some missing upper teeth, have a perceived need to have denture work, and have smoked for a number of years. The results suggest that this rural population is retaining more teeth and consequently may need and may seek dental services more often than previous more edentulous cohorts.

Why are we ‘weighting’? An assessment of a self-weighting approach to measuring oral health-related quality of life

OBJECTIVE

To determine whether or not self-weighting at an item level contributes to the performance of an oral health-related quality-of-life measure.

DESIGN

Data were collected in two national surveys conducted a month apart, one using the "weighted" measure and the other an "unweighted" version of the UK oral health-related quality-of-life measure. In addition, sociodemographic and self-reported oral health status were recorded.

RESULTS

The UK oral health-related quality-of-life measure discriminated between groups based on age group (<65, 65 and older) and social class (higher and lower) irrespective of the version of the questionnaire used. Both versions also showed significant associations with self-reported oral health: denture status (P < 0.01) and number of teeth possessed (P < 0.01). In addition, both versions demonstrated predictive ability in identifying those in prosthetic need (<20 teeth and without recourse to a denture, P < 0.01).

CONCLUSION

Weighting the UK oral health-related quality-of-life instrument does not improve the psychometric properties of the instrument and thus raises questions about the value of self-weighting at an item level.

Socioeconomic and demographic disparities in symptoms of orofacial pain

OBJECTIVES

The purpose of this study was to document the association between socioeconomic status (SES) and the prevalence and impact of orofacial pain by anatomical location. In addition, differential effects of SES on orofacial pain across levels of sex, race, and age were documented.

METHODS

The subjects were 724 participants in the Florida Dental Care Study, a study of oral health among dentate adults, aged 45 years and older at baseline. Pain prevalence and subjective ratings were assessed for a range of orofacial pain sites using a standardized telephone interview.

RESULTS

Lower SES was associated with reporting pain and pain impact at many, but not all, of the orofacial sites. Some sex, race, and age cohort differences in orofacial pain were found when adjusting for differences in socioeconomic position. The most consistent result, as evidenced by similar findings across orofacial pain sites, was that the effects of SES on orofacial pain appear to have a sex-differentiated effect.

CONCLUSION

Consistent with findings for other subjective measures of oral health, persons of lower SES are at increased risk for orofacial pain and pain-related behavioral impact.

The impact of stomatological disease on oral health-related quality of life

The clinical diagnosis of stomatological disease may indicate its cause and prognosis; however, it says little about the resulting level of impairment from the patient's perspective. The primary objective of this study was to test whether patients attending an outpatient oral medicine clinic would have worse oral health related quality of life (OHR-QoL) compared with the general population. In addition, we aimed to assess whether anxiety or depression could be predicted by OHR-QoL and to explore the relationship between clinical diagnoses, OHR-QoL and anxiety/depression. Data were collected from patients (n = 97) through face-to-face interviews using the Oral Health Impact Profile Short form (OHIP-14) to measure OHR-QoL, the Hospital Anxiety and Depression Scale (HADS) for psychiatric morbidity, and a visual analogue scale for self-rated general health. Age- and sex-matched controls (n = 388) were provided from a normative data set collected in a UK national survey in 1998. Participants had significantly lower OHR-QoL scores than the general population on all domains and overall OHR-QoL scores. Of the variance in anxiety, 55% was predicted by general health ratings and OHR-QoL domains of 'psychological discomfort' and 'psychological disability'. Of the variance in depression, 54% was predicted by general health ratings and OHR-QoL domains of 'functional limitation' and 'social disability'. Patient centred, routine assessment of OHR-QoL provides an additional dimension that may help to improve awareness of the impact of disease on the individual's life and enhance the clinical decision-making process.

A general dental practice research network: impact of oral health in general dental practice patients

OBJECTIVE

To measure the subjective impact of oral health in a group of patients attending general dental practices in the North West of England and to investigate the attributes of dentists and practices in order to examine how such attributes might relate to patients' subjective perceptions of oral health.

DESIGN

Fifteen general dental practices conducting a simultaneous survey of attending patients and 15 practitioners from these practices providing information about their attitudes to treatment, prevention and various aspects of their surgery.

SETTING

General dental

OUTCOME MEASURES

Patient subjective impact scores. Relationships between practice and practitioner variables and patients' subjectively perceived oral health.

RESULTS

Fifteen practitioners with diverse practice attributes provided data on 718 patients. The mean total oral health impact score was 18.4. Twenty two per cent of patients had experienced pain in the four weeks before the survey and 11% had been unable to chew some foods. Fifty five per cent of the surveyed population had, in the previous year, worried about the appearance of their mouth and 65% had worried about their oral health in general. Dentists' beliefs were related to patient impact scores but practice attributes were not significantly associated with patients' impacts.

CONCLUSIONS

Fourteen percent of the differences in patients' subjectively perceived oral health can be attributed to dentist attitudes and attributes. Further research regarding the influence of dentists personality and professional beliefs on patients well-being needs to be undertaken.

The self-assessed oral health status of individuals from White, Indian, Chinese and Black Caribbean communities in South-east England

OBJECTIVES

To determine the level of self-assessed oral symptoms and the impact of such symptoms among individuals from four ethnic groups resident in South-east England and the relationship between self-assessed oral health status, age, gender, employment status, educational level and ethnicity.

METHOD

Cross-sectional survey of a convenience sample of 366 individuals drawn from four ethnic groups.

MEASURES

Subjective Oral Health Status Indicators (SOHSI).

PARTICIPANTS

Individuals were recruited through community groups. All participants self-classified their ethnicity. Only completed questionnaires from participants categorising themselves as White, Black Caribbean, Chinese or Indian were included in the data analysis.

FINDINGS

Univariate statistical analysis revealed significant differences between ethnic groups in all but one of the SOHSI scales. Age and ethnicity (in particular membership of the Chinese community) emerged as significant predictors of SOHSI scale scores.

CONCLUSIONS

Within the limitations imposed by convenience sampling, it has been found that differences exist among four ethnic groups in the UK in their reporting of self-assessed oral health status. Ethnicity and age, in particular, predict the reporting of self-assessed oral symptoms and the impact of such symptoms.

Why is pain more common amongst people living in areas of low socio-economic status? A population-based cross-sectional study

STUDY OBJECTIVE

To confirm a relationship between self-reported oro-facial pain and deprivation using an area-based measure of deprivation, and to investigate possible mechanisms of the association.

DESIGN

A cross sectional population based survey.

SETTING

General medical practice in South-East Cheshire (Borough of Congleton, North West England).

PARTICIPANTS

Two thousand, five hundred and four people aged 18-65 years living in the community.

METHODS

A postal questionnaire was sent which asked about pain in the oro-facial region. Information on factors which may 'explain' any relationship between pain and social class was collected: psychological distress, maladaptive responses to illness, sleep problems and local mechanical factors such as teeth grinding and facial trauma. Participants were allocated a Townsend index deprivation score on the basis of their postcode.

MAIN RESULTS

The study achieved an adjusted participation rate of 74% (N = 2,504) and the overall prevalence of oro-facial pain was 26%. Statistical analysis revealed that people in the most deprived areas were more likely to report oro-facial pain compared with the most affluent ones [OR 1.50 (95% confidence interval 1.09, 2.07)]. This relationship remained after adjusting for all potential confounding factors.

CONCLUSION

While the relationship between oro-facial pain and deprivation exists, the mechanisms of such relationships are not clear. Local mechanical factors, trauma or psychological distress did not explain it. The factors linking pain with social deprivation remain to be elucidated.

Testing a model of the relationship between gender, ethnicity, clinical status and impact in older adults from minority ethnic groups

OBJECTIVE

To identify the relationship between indicators of self-assessed symptom status, the reported impact of oral conditions and clinical indices, and the extent to which this relationship was moderated by gender and ethnicity.

DESIGN

Secondary analysis of data from an oral health survey of minority ethnic groups.

PARTICIPANTS

Purposive sample of 376 individuals from minority ethnic groups in the United Kingdom recruited through community groups.

MEASURES

Numbers of decayed, missing and filled teeth. Measures of self assessed symptoms, and impact upon quality of life.

RESULTS

Impact of oral conditions upon lifestyle was predicted by the number of missing teeth, the presence of pain on eating certain foods and the presence of toothache in the previous four weeks. Social variables (gender and ethnicity) did not predict impact either singly or through interaction with symptoms.

CONCLUSIONS

The findings support a linear model of the relationship between the experience of oro-facial symptoms and impact on everyday life amongst older adults.

Measuring the impact of oral health on life quality in two national surveys - functionalist versus hermeneutic approaches

OBJECTIVES

This study compares a functionalist (quantitative) versus a hermeneutic (qualitative) approach to assessing the impact of oral health on life quality in two United Kingdom national surveys.

METHODS

The vehicles for this study were two Office for National Statistics' Omnibus Surveys completed in 1998 and 1999. In both studies a random probability sample of 3000 household addresses was selected from the British Postcode Address File (PAF). The data were collected by face-to-face interviews with respondents in their homes about how their oral health status affected their quality of life employing a qualitative, hermeneutic approach (1998) and a functionalist, quantitative approach using a battery of questions (1999).

RESULTS

Irrespective of study design, in both studies it was apparent that the majority of the public perceived their oral health as affecting their life quality (P > 0.05). Likewise, both approaches identified that oral health affected life quality most frequently through physical aspects of oral health rather than social or psychological. However, using the hermeneutic approach, respondents were less likely to cite that their oral health affected specific aspects of their oral health compared to when a battery of questions were used (P < 0.01). Furthermore, socio-demographic variations in oral health-related quality of life were more apparent when a battery of questions were employed compared to an open-ended approach.

CONCLUSIONS

Different approaches to assessing oral health-related quality of life yield similar findings in terms of prevalence of oral health's impact and affected ways (domains). However, the different methods influenced the ability to identify socio-demographic disparities.

Racial differences in orofacial pain

This study investigated racial differences in the subjective report of orofacial pain in a stratified sample of adults dwelling in the community. The subjects were 724 participants in the Florida Dental Care Study, a longitudinal study of oral health among dentate adults aged 45 years and older at baseline. Pain prevalence and subjective ratings were assessed for a range of orofacial pain sites by means of a standardized telephone interview. The results suggest that white respondents were more likely to report painful oral sores than were black respondents (19.0% vs 6.3%). As was consistent with findings from patients seeking health care and laboratory-based experimental pain studies, a higher percentage of black subjects rated pain as severe enough to have an impact on behavior for temperature sensitivity (59.6% vs 30.3%), pain when chewing (70.0% vs 40.0%), and painful oral sores (53.8% vs 27.9%). These racial differences were most apparent within male sex for temperature sensitivity, pain when chewing, and toothache pain, with black men rating pain as more severe than white men. For jaw joint pain and painful oral sores, both black and white women rated pain as more severe than did white men. This study has documented race by sex interactions in the impact from orofacial pain across multiple symptoms in a community-based sample.

Oral ill-health and deprivation among patients of a general dental practice in South Wales

PURPOSE OF STUDY

This study aims to establish and report on whether individuals from deprived areas suffer more ill health than adults from areas considered not to be deprived when visiting a general dental practice.

BASIC PROCEDURES

Between December 1998 and June 1999 registered dental patients over 18 years of age attending for routine care completed a questionnaire measuring functional, experiential and psychosocial impact of oral ill health. In addition the clinical impact of ill health was established from the patient examination and record card. Clinical outcome was assessed by numbers of standing teeth, oral health was assessed using the Subjective Oral Health Status Indicators (SOHSI). The patient's postcode was used to categorise individuals from areas of different deprivation states.

MAIN FINDINGS

99% were dentate with 88.4% having more than 20 teeth. A total of 71.8% were able to eat satisfactorily, 88.2% were able to speak satisfactorily, 54.6% were discontent, 99.4% were worried about their oral health and appearance, 62.8% were satisfied with their oral health, 44.8% experienced discomfort, 65.8% experienced other symptoms, and 86.8% experienced 'general well-being'. No differences were observed for clinical measures between the deprived groups. Only three out of eight oral health measures showed any differences between the deprived groups, namely, ability to speak, discontent and general well-being. More individuals from deprived areas experienced these impacts.

PRINCIPAL CONCLUSIONS

It was anticipated that individuals from deprived areas would experience greater ill-health: this outcome was not as marked as expected.

Impact of traumatic injuries to the permanent teeth on the oral health-related quality of life in 12-14-year-old children

BACKGROUND/AIM

There are no data on the impacts on daily living of traumatic injuries to the permanent teeth. The aim of the present study was to assess the socio-dental impacts of untreated fractured anterior teeth in Brazilian schoolchildren.

METHODS

A population-based matched case-control study was used and a 2 : 1 control-to-case ratio was adopted. The cases were 68 children 12-14 years old, having non-restored teeth, with fracture involving dentine. The controls were 136 children without any traumatic dental injury. They were matched by age, sex and socio-economic status. The Oral Impact on Daily Performances (OIDP) index was used to measure the impacts.

RESULTS

The response rate was 100%. Results of conditional logistic regression showed that children with fractured teeth were 20 times (95% CI = 2.2-45.6) more likely to report any impact on their daily living than children with no traumatic dental injury. These results remained statistically significant for the items of the OIDP separately, 'smiling' (P < 0.001), 'maintaining emotional state' (P < 0.001), 'eating' (P < 0.01), 'enjoying contact with people' (P < 0.01) and the overall OIDP (P < 0.001), after adjusting for confounding variables such as the Aesthetic Component of the Index of Orthodontic Treatment Need and DMFT index in a multiple conditional logistic regression.

CONCLUSIONS

Children with untreated dental fracture of permanent teeth had more impacts on their daily living than children without any traumatic injury.

Validity of a questionnaire survey: response patterns in different subgroups and the effect of social desirability

Questionnaire surveys are often used in epidemiology and survey research. However, investigations have shown that the method suffers from biases. If the intention is to examine differences between subgroups in a sample, studies have shown that people tend to give answers to questionnaires more according to a social norm than to the actual situation. This has been called social desirability. The aim of this study was to investigate response bias in subgroups of a sample in a large questionnaire survey (n = 9,200) and to study whether social desirability has an impact on survey results in dental research. The answers were divided into subgroups according to gender, age, and residence and were compared with corresponding data from dental insurance claims. The levels of agreement were found to vary considerably and the differences were highly statistically significant. The variation in agreement showed that bias on the group level increased when the distance from an anticipated social norm was larger. This implies that the divergence from a socially desirable mode of action influences the magnitude of the bias.

Evaluation of a modified version of the index of Oral Impacts On Daily Performances (OIDP) in elderly populations in two European countries

OBJECTIVE

To examine the psychometric properties of a modified version of the index of Oral Impacts on Daily Performance (OIDP) in elderly populations in two European countries, namely Great Britain and Greece. The psychometric properties examined in this study refer to internal consistency and face, content, criterion and construct validity.

DESIGN AND SETTING

Cross-sectional epidemiologic surveys of independently living people aged 65 years or older. Data were collected by interviewers through structured questionnaires. The British sample consisted of the randomly selected independently living persons that participated in the dental component of the National Diet and Nutrition Survey (NDNS) of adults aged 65 years or over. The Greek sample is an opportunity sample drawn from eligible people living in two municipalities of the Athens region.

SUBJECTS

753 people participated in the British and 681 in the Greek sample.

RESULTS

Through pilot work in both countries, the OIDP index was modified and both Greek and British modified versions demonstrated satisfactory face and content validity. In the main studies, Cronbach's alpha of the modified OIDP was 0.77 for the Greek and 0.69 for the British sample. In both samples, the index showed very significant associations with perceived dental treatment need (p<0.001), perceived general health (p<0.001 in Greek, p=0.002 in British) and intermediate oral impacts (p<0.001), as well as with satisfaction with oral health in the Greek sample (p<0.001).

CONCLUSIONS

Overall, this study has demonstrated that the modified OIDP is a valid and reliable measure of oral health related quality of life in elderly people in Great Britain and Greece.

Systematic review of population-based epidemiological studies of oro-facial pain

OBJECTIVES

To conduct a systematic review of epidemiological literature in order to determine the prevalence and associated risk factors of oro-facial pain.

DATA

Population based observational studies (cohorts, cross-sectional and case-control studies) of oro-facial pain, published in the English language, prior to 1999 were included.

SOURCES

Electronic databases (Medline, Embase, Cinahl, BIDS and Health CD) were searched. Reference lists of relevant articles were examined, and the journals "Pain" and "Community Dentistry and Oral Epidemiology" were handsearched for the years 1994-1998.

RESULTS

The results of the search strategy were screened for relevance. A standardised checklist was used to assess the methodological quality of each study by two reviewers before an attempt was made to summarise the results. The median quality score was 70% of the maximum attainable score. Due to methodological issues, it was not possible to pool the data on the prevalence of oro-facial pain. Age, gender and psychological factors were found to be associated with OFP, however there was not enough information on other factors such as local mechanical and co-morbidities to draw any reliable conclusions. None of the factors fully fulfilled criteria for causality.

CONCLUSIONS

There is a need for good quality epidemiological studies of oro-facial pain in the general population. To enable comprehensive examination of the aetiology of oro-facial pain, it is necessary to address a broad range of factors including demography and life-style, local mechanical factors, medical history and psychological factors. Future studies should recruit adequately sized samples for precise determination of the prevalence and detection of important associated factors. Data on potential confounders and effect modifiers should also be collected and adjusted for in the statistical analysis.

Self-perceived oral health status, psychological well-being, and life satisfaction in an older adult population

Numerous studies have demonstrated that many older adults have problems chewing, pain, difficulties in eating, and problems in social relationships because of oral disorders. However, it is not clear if these functional and psychosocial outcomes affect broader psychological well-being and life satisfaction. Consequently, this paper begins to address the question, 'Does poor oral health compromise the quality of life?'. Initial cross-sectional analyses used data derived from the seven-year follow-up of the Ontario Study of the Oral Health of Older Adults. As at baseline and three-year follow-up, oral health was measured by self-ratings of oral health and five oral health indices. Psychological well-being and life satisfaction were assessed according to the Morale Index, the Perceived Life Stress Questionnaire, The Life Satisfaction Scale, and the General Health Questionnaire. All oral health variables were significantly associated with scores from the first three of these measures in the expected direction. These associations remained after we controlled for other potential influences on the quality of life. In addition, prospective analysis indicated that self-perceived oral health at three years had a significant independent effect on psychological well-being and life satisfaction at seven years. These results suggest that poor self-perceived oral health and relatively poor quality of life co-exist in the same subgroup of older adults.

The oral health of older people from minority ethnic communities in south east England

OBJECTIVES

To describe the clinical health status and subjective oral health status of older adults from minority ethnic communities resident in South East England.

DESIGN

Cross sectional survey incorporating a clinical examination and a questionnaire assessment of subjective oral health status.

SETTING

Community groups working with individuals from minority ethnic communities.

SUBJECTS

A total of 540 individuals from 7 minority ethnic communities.

MEASURES

Clinical assessment of oral health status using BASCD criteria. Assessment of oral symptoms and impact experienced together with satisfaction with oral status, by structured questionnaire.

RESULTS

On all measures of clinical health status the participants were healthier than a comparison group based on data from the Adult Dental Health Survey. The participants expressed high levels of subjective oral symptoms. Levels of satisfaction were lower than those found in the Adult Dental Health Survey. There was evidence of some variation across minority ethnic communities in clinical and subjective oral health status.

CONCLUSIONS

Approximately 20% of the 540 adults from minority ethnic communities resident in the South East of England surveyed were relatively fit orally. They experienced a great many oral symptoms, and in approximately 30% of individuals these were sufficient to interfere with their quality of life.

ETHICAL APPROVAL

The research described in this paper was approved by the Ethics committee of King's College London.